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Bebbington E, Kakola M, Majgi SM, Krishna M, Poole R, Robinson C. Exploring misclassification of injury intent: A burn register study. Burns 2024; 50:1735-1745. [PMID: 38862344 DOI: 10.1016/j.burns.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/30/2024] [Accepted: 05/02/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Burn registers are an important source of surveillance data on injury intent. These data are considered essential to inform prevention activities. In South Asia, intentional burn injuries are thought to disproportionately affect women. Assessment of injury intent is difficult because it is influenced by personal, family, social, and legal sensitivities. This can introduce misclassification into data, and bias analyses. We conducted a descriptive, hypothesis generating study to explore misclassification of injury intent using data from a newly digitised single centre burn register in south India. METHODS Data from 1st February 2016 to 28th February 2022 were analysed. All patients in the data set were included in the study (n = 1930). Demographic and clinical characteristics for patients are described for each classification of injury intent. All data cleaning and analyses were completed using RStudio. RESULTS Injury intent data were missing for 12.6% of cases. It was the most commonly missing variable in the data set. "Accidental" injuries had a similar distribution over time, age, and total body surface area (TBSA) for males and females. "Homicidal" injuries were more common in females. Injuries reported as "Suicidal" affected men and women equally. A decrease in reporting of "Suicidal" injuries in females corresponded to an increase in high TBSA injuries classified as 'Other' or with missing data. Overwriting of injury intent was present in 1.5% of cases. The overwritten group had a greater proportion of females (62.1% vs. 48.5%) and higher median TBSA (77.5% vs. 27.5%) compared to the group where intent was not overwritten. CONCLUSION Our findings indicate that some subgroups, such as females with high TBSA burns, appear to be more likely to be misclassified and should be the focus of future research. They also highlight that quality of surveillance data could be improved by recording of clinical impression, change in patient reported intent, and use of a common data element for intent to standardise data collection. We also recommend that injury intent is recorded as a unique variable and should not be mixed with other elements of injury causation (e.g. mechanism). Although this is a single centre study, the methods will be of interest to those who utilise routinely collected data and wish to reduce misclassification of this important variable.
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Affiliation(s)
- Emily Bebbington
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, LL13 7YP, UK.
| | - Mohan Kakola
- Department of Plastic Surgery and Burns, Mysore Medical College and Research Institute, KR hospital, Irwin Road, Mysuru, Karnataka 570001, India
| | - Sumanth Mallikarjuna Majgi
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India
| | - Murali Krishna
- Institute of Public Health 3009, II-A Main, 17th Cross, KR Rd, Siddanna Layout, Banashankari Stage II, Banashankari, Bengaluru, Karnataka 560070, India
| | - Rob Poole
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, LL13 7YP, UK
| | - Catherine Robinson
- Social Care and Society, School of Health Sciences, Faculty of Biology, Medicine and Health, Jean McFarlane Building, Oxford Road, Manchester M13 9PY
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Adhikari S, Gurung R, Bastakoti S, Alrasheedy AA, KC B. Burn pain management in a female patient with severe burn injuries in Nepal: a case study and review. Pain Manag 2024; 14:323-329. [PMID: 39101437 PMCID: PMC11340753 DOI: 10.1080/17581869.2024.2382072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.
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Affiliation(s)
- Sundar Adhikari
- Department of Pharmacy, Fishtail Hospital and Research Center, Pvt. Ltd., Gairapatan-4, Pokhara, Nepal
| | | | - Suresh Bastakoti
- Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Kathmandu, Nepal
| | | | - Bhuvan KC
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Kunwar A, Shrestha P, Shrestha S, Thapa S, Shrestha S, Amatya NM. Detection of biofilm formation among Pseudomonas aeruginosa isolated from burn patients. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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4
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Kazerooni Y, Mishra B, Gibran N, Adu E, Clarke D, Pham T, Stewart BT. A systematic review and comprehensive legislative framework to address chemical assault globally. Health Policy Plan 2021; 35:1188-1207. [PMID: 33450768 DOI: 10.1093/heapol/czaa031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
The incidence of chemical assault is increasing globally. In response, a number of countries are proposing legislation. However, current legislative initiatives are uncoordinated and do not address the spectrum of activities to prevent and care for victims of chemical assaults. To fill this gap, we aimed to review legislation, policies and regulations relevant to chemical assault to classify and catalogue current strategies into a legislative framework. Terms related to chemical assault were used to systematically search the academic, lay and legal literatures. Chemical assault was defined as the use of acid or another caustic or corrosive substance or vitriol by one person against another with the intent to injure or disfigure. Reports that described the use of chemical weapons in warfare were excluded. A second search of national legislations of countries with reports of chemical assaults was performed to identify enacted laws and gaps in legislative approaches to chemical assault control. Data regarding relevant laws, policies and regulations were extracted. The findings were used to classify and catalogue current strategies into a legislative framework using content analysis. The search returned 3769 records. Chemical assaults were reported from 104 countries. Using legislation from those countries, a framework consisting of five legislative priorities was developed: (a) apply a public health approach; (b) adopt legal definitions specific to chemical assault; (c) control chemical supply, sales and procurement; (d) facilitate justice; and (e) support survivors. Although many countries have implemented one or more of these legislative priorities, no country has a comprehensive address to chemical assault control. Comparative policy analysis and assessments of the impacts of legislative efforts may further inform strategies to prevent, prosecute and mitigate the impact of chemical assaults. In the meantime, advocacy groups and governments might consider implementation and enforcement of one or more components of this legislative framework to control the growing epidemic of chemical assault.
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Affiliation(s)
- Yasaman Kazerooni
- Department of Surgery, Wexner Medical Center, The Ohio State University, 395 W 12th Ave #670, Columbus, OH 43210 2, USA
| | - Brijesh Mishra
- Department of Plastic, Reconstructive and Aesthetic Surgery, King Georges Medical University, Shah Mina Rd, Chowk, Lucknow, Uttar Pradesh 226003, India
| | - Nicole Gibran
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Box 359796, 325 Ninth Ave, Seattle, WA 98104, USA
| | - Emmanual Adu
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Provost Office, College of Health Sciences KNUST-Kumasi, Kumasi, Ghana
| | - Damian Clarke
- Metropolitan Trauma Service Pietermaritzburg, Department of General Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, 719 Umbilo Rd, Umbilo, Berea, 4001 Durban, South Africa
| | - Tam Pham
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Box 359796, 325 Ninth Ave, Seattle, WA 98104, USA
| | - Barclay T Stewart
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Box 359796, 325 Ninth Ave, Seattle, WA 98104, USA.,Department of Interdisciplinary Health Sciences, Stellenbosch University Private Bag X1, Matieland, 7602, Stellenbosch, South Africa.,Department of Surgery, Harborview Injury Prevention and Research Center, Seattle, WA, USA
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Li K, Mehta K, Wright A, Lee J, Yadav M, Pham TN, Rai SM, Nakarmi K, Stewart B. Identifying Hospitals in Nepal for Acute Burn Care and Stabilization Capacity Development: Location-Allocation Modeling for Strategic Service Delivery. J Burn Care Res 2021; 42:621-626. [PMID: 33891676 DOI: 10.1093/jbcr/irab064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In Nepal, preventable death and disability from burn injuries are common due to poor population-level spatial access to organized burn care. Most severe burns are referred to a single facility nationwide, often after suboptimal burn stabilization and/or significant care delay. Therefore, we aimed to identify existing first-level hospitals within Nepal that would optimize population-level access as "burn stabilization points" if their acute burn care capabilities are strengthened. A location-allocation model was created using designated first-level candidate hospitals, a population density grid for Nepal, and road network/travel speed data. Six models (A-F) were developed using cost-distance and network analyses in ArcGIS to identify the three vs five candidate hospitals at ≤2, 6, and 12 travel-hour thresholds that would optimize population-level spatial access. The baseline model demonstrated that currently 20.3% of the national population has access to organized burn care within 2 hours of travel, 37.2% within 6 travel-hours, and 72.6% within 12 travel-hours. If acute burn stabilization capabilities were strengthened, models A to C of three chosen hospitals would increase population-level burn care access to 45.2, 89.4, and 99.8% of the national population at ≤2, 6, and 12 travel-hours, respectively. In models D to F, five chosen hospitals would bring access to 53.4, 95.0, and 99.9% of the national population at ≤2, 6, and 12 travel-hours, respectively. These models demonstrate developing capabilities in three to five hospitals can provide population-level spatial access to acute burn care for most of Nepal's population. Organized efforts to increase burn stabilization points are feasible and imperative to reduce the rates of preventable burn-related death and disability country-wide.
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Affiliation(s)
- Kevin Li
- Department of Bioinformatics and Medical Education, University of Washington, Seattle, USA
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, USA
| | - Ada Wright
- Carleton College, Northfield, Minnesota, USA
| | - Joohee Lee
- Public Health Concern Trust Nepal, Kathmandu, Nepal
| | - Manish Yadav
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington and UW Medicine Regional Burn Center, Seattle, USA
| | - Shankar M Rai
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Kiran Nakarmi
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Barclay Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington and UW Medicine Regional Burn Center, Seattle, USA.,Harborview Injury Prevention & Research Center, Seattle, Washington, USA
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Lowin JL, Poudel AN, Price PE, Potokar TS. A Structured Review to Assess the Current Status of Cost-Based Burns Research in Nepal. J Burn Care Res 2020; 42:93-97. [PMID: 32780811 PMCID: PMC7856442 DOI: 10.1093/jbcr/iraa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The management of burns is costly and complex. The problem is compounded in low and middle income countries (LMICs) where the incidence of burn injuries is high but infrastructure and funding for management and prevention is limited. Cost of illness studies allows for quantification of the costs associated with public health problems. Without cost quantification, focus and allocation of funding is challenging. The authors explored the availability of cost-focused burns research data in a target LMIC. The focus of their research was Nepal. A structured literature review including published papers, Ministry of Health (MOH) and World Health Organization (WHO) statistics was conducted to identify cost of illness studies or evidence relating to burn-related resource and costs. Gaps in the evidence base were highlighted. Research methodologies from other LMICs were reviewed. We found 32 papers related to burn injury in Nepal, one key MOH document and one relevant WHO data source. Most research focused on the epidemiology and etiology of burns in Nepal. Of the papers, only 14 reported any type of burn-related resource use and only 1 paper directly reported (limited) cost data. No studies attempted an overall quantification of the cost of burns. MOH statistics provided no additional insight into costs. Our study found an almost complete lack of cost-focused burns research in Nepal. Primary research is needed to quantify the cost of burns in Nepal. Initial focus could usefully be on the cost of care in tertiary hospitals. A full cost of burns for Nepal remains some way off.
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Affiliation(s)
- Julia L Lowin
- Swansea Centre for Health Economics (SCHE), Swansea University
| | | | - Patricia E Price
- Interburns, Welsh Centre for Burns and Plastic Surgery.,Centre for Global Burn injury Policy and Research, Swansea University, Swansea, UK
| | - Tom S Potokar
- Interburns, Welsh Centre for Burns and Plastic Surgery.,Centre for Global Burn injury Policy and Research, Swansea University, Swansea, UK
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Shakya R, Manandhar M, Dangol R, Shrestha A. Cross cultural adaptation and validation of burn specific health scale- brief in Nepali (BSHS-B-Np). J Patient Rep Outcomes 2020; 4:25. [PMID: 32323083 PMCID: PMC7176760 DOI: 10.1186/s41687-020-00190-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burns are a global health problem affecting the survivors and disrupting many aspects of their lives. It is the second most common injury in rural Nepal accounting 5% of disabilities. Burn Specific Health Scale (BSHS) is a valid and most commonly used tool to measure Health Related Quality of Life (HRQoL) of the patient with Burns. BSHS- B (Brief) has been translated, culturally adapted and validated in multiple languages but not in Nepali. Therefore we aim to translate, culturally adapt and validate the BSHS-B in Nepali language (BSHS-B-Np). METHODS Standard guideline was followed to translate the scale into Nepali language. One hundred eleven participants were evaluated to establish the psychometric properties of BSHS-B-Np. Internal consistency, test retest, content validity, discriminant validity and construct validity were assessed using Cronbach's alpha, Interclass correlation coefficient, Factor analysis, Spearman rank test, and Mann- Whitney U test respectively. RESULTS The Cronbach's alpha for BSHS-B-Np was 0.93. Test retest inter-class correlation coefficient was between 0.92 and 0.98. The principal component factor analysis with varimax rotation resulted in separation of nine factors explaining 75.19% of total variance. BSHS-B-Np showed good discriminant validity in 35 out of 36 domain correlations confirming the construct of the scale. Furthermore, the scale was able to discriminate between face, upper limb and lower limb injury (p < 0.05). CONCLUSIONS BSHS-B-Np is a reliable and valid scale for Nepali burns survivors to assess their health related quality of life.
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Affiliation(s)
- Regan Shakya
- Department of Physiotherapy, Kathmandu University School of Medical Sciences/ Dhulikhel Hospital, Dhulikhel, Nepal.
| | - Misu Manandhar
- Department of Physiotherapy, Kathmandu University School of Medical Sciences/ Dhulikhel Hospital, Dhulikhel, Nepal
| | - Roshan Dangol
- Department of Physiotherapy, Sushma Koirala Memorial Hospital, Kathmandu, Nepal
| | - Archana Shrestha
- Department of Community Programs, Kathmandu University School of Medical Sciences/ Dhulikhel Hospital, Dhulikhel, Nepal
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Phuyal K, Ogada EA, Bendell R, Price PE, Potokar T. Burns in Nepal: a participatory, community survey of burn cases and knowledge, attitudes and practices to burn care and prevention in three rural municipalities. BMJ Open 2020; 10:e033071. [PMID: 32114463 PMCID: PMC7050363 DOI: 10.1136/bmjopen-2019-033071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES As part of an ongoing, long-term project to co-create burn prevention strategies in Nepal, we collected baseline data to share and discuss with the local community, use as a basis for a co-created prevention strategy and then monitor changes over time. This paper reports on the method and outcomes of the baseline survey and demonstrates how the data are presented back to the community. DESIGN A community-based survey. SETTING Community based in three rural municipalities in Nepal. PARTICIPANTS 1305 households were approached: the head of 1279 households participated, giving a response rate of 98%. In 90.3% of cases, the head of the household was male. RESULTS We found that 2.7% (CI 1.8 to 3.7) of 1279 households, from three representative municipalities, reported at least one serious burn in the previous 12 months: a serious burn was defined as one requiring medical attention and/or inability to work or do normal activities for 24 hours. While only 4 paediatric and 10 adult cases in the previous 12 months reached hospital care, the impact on the lives of those involved was profound. Only one patient was referred on from primary to secondary/tertiary care; the average length of hospital stay for those presenting directly to secondary/tertiary care was 21 days. A range of first-aid behaviours were used, many of which are appropriate for the local context while a few may be potentially harmful (eg, the use of dung). CONCLUSION The participatory approach used in this study ensured a high response rate. We have demonstrated that infographics can link the pathway for each of the cases observed from initial incident to final location of care.
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Affiliation(s)
| | - Edna Adhiambo Ogada
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Patricia E Price
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
- Interburns, Swansea, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
- Interburns, Swansea, UK
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Pant PR, Banstola A, Bhatta S, Mytton JA, Acharya D, Bhattarai S, Bisignano C, Castle CD, Prasad Dhungana G, Dingels ZV, Fox JT, Kumar Hamal P, Liu Z, Bahadur Mahotra N, Paudel D, Narayan Pokhrel K, Lal Ranabhat C, Roberts NLS, Sylte DO, James SL. Burden of injuries in Nepal, 1990-2017: findings from the Global Burden of Disease Study 2017. Inj Prev 2020; 26:i57-i66. [PMID: 31915272 PMCID: PMC7571348 DOI: 10.1136/injuryprev-2019-043309] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 12/11/2022]
Abstract
Background Nepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition. Methods The Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017. Results There were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death. Conclusions The increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions.
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Affiliation(s)
- Puspa Raj Pant
- Centre for Academic Child Health (CACH), University of the West of England, Bristol, UK
| | - Amrit Banstola
- Centre for Academic Child Health (CACH), University of the West of England, Bristol, UK.,Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
| | - Santosh Bhatta
- Centre for Academic Child Health (CACH), University of the West of England, Bristol, UK
| | - Julie A Mytton
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Dilaram Acharya
- Department of Preventive Medicine, Dongguk University, Gyeongju, South Korea.,Department of Community Medicine, Kathmandu University, Devdaha, Nepal
| | - Suraj Bhattarai
- London School of Hygiene & Tropical Medicine, London, UK.,Nepal Academy of Science & Technology, Patan, Nepal
| | - Catherine Bisignano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Pawan Kumar Hamal
- Department of Anaesthesiology and Intensive Care, National Academy of Medical Sciences, Kathmandu, Nepal.,Journal of Nepal Health Research Council, Nepal Health Research Council, Kathmandu, Nepal
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Deepak Paudel
- Health, Nutrition and HIV/AIDS Program, Save the Children, Kathmandu, Nepal.,Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Khem Narayan Pokhrel
- HIV and Mental Health Department, Integrated Development Foundation Nepal, Kathmandu, Nepal
| | - Chhabi Lal Ranabhat
- Policy Research Institute, Kathmandu, Nepal.,Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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11
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Review of the First 108 Free Flaps at Public Health Concern Trust-NEPAL Hospitals: Challenges and Opportunities in Developing Countries. Ann Plast Surg 2019; 81:565-570. [PMID: 30161043 DOI: 10.1097/sap.0000000000001583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Free tissue transfer is one of the most important and essential techniques in reconstructive surgery. The underlying complexity, steep learning curve, high cost, and fear of failure make it very difficult to establish as a regular service in developing countries such as Nepal. METHODS A retrospective cohort study design was used to analyze the challenges with and opportunities for reconstructive surgery in Nepal. Medical records were reviewed for patient demographics, indications, types of free flaps, hospital stay, complications, and involvement of a microsurgery teaching workshop. RESULTS A total of 16 microsurgical workshops were carried out by 3 international organizations over the study period (2007-2017). Altogether 108 free flaps in 103 subjects were reviewed during the study period at different hospitals of the Public Health Concern Trust-NEPAL (phect-NEPAL) and National Trauma Center. Of 103 patients, 60 were males and 43 were females with an average age of 34.5 years (range, 8-73 years). The most common indications for microsurgical reconstruction were tumor, trauma, and burns. Radial artery forearm flap, anterolateral thigh flap, and free fibular flap were the most common types of flaps. Ten different types of flaps were performed. Four cases needed more than 1 flap; one of them needed 3 flaps. Flap success rate approached 90%. Four patients died in the hospital postoperatively. CONCLUSION Reconstructive microsurgery is challenging in Nepal and more generally in developing settings. However, persistent technical support such as training and workshops can make it feasible.
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Mytton J, Bhatta S, Thorne M, Pant P. Understanding the burden of injuries in Nepal: A systematic review of published studies. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1673654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- J.A. Mytton
- University of the West of England, Bristol, UK
| | - S. Bhatta
- University of the West of England, Bristol, UK
| | - M. Thorne
- University of the West of England, Bristol, UK
| | - P.R. Pant
- University of the West of England, Bristol, UK
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Knulst AJ, Gupta S, Groen RS, Maharjan D, Kapendra AS, Dankelman J, Kushner AL. Directions for surgical capacity developments in Nepal: a population-based assessment. Trop Med Int Health 2019; 24:1128-1137. [PMID: 31328362 PMCID: PMC6852409 DOI: 10.1111/tmi.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Lack of access to safe surgery is seen as a major issue that needs to be addressed. The aim of this study was to understand which combinations of factors relate to high occurrences of unmet needs and disability in Nepal, and consequently, how to focus future work to maximise impact in this country. Methods A large population‐based survey was conducted in Nepal in 2014 to evaluate the unmet surgical needs that result in disability. Recorded factors included diseased anatomical areas, disease specifics, disease locations, injury types, reasons for having an unmet need and the types of disability. Results Included in the study were 2695 individuals. The anatomical areas facing the highest disabling unmet surgical need were Head (3.9% of population), Groin/Genitalia (2.2% of population) and Extremities (3.6% of population). Four focus areas could be defined. Increase affordability, availability and acceptability of surgical care to non‐traumatic disabling conditions of (i) the eye, and (ii) extremities, and (iii) to traumatic disabling conditions of extremities and finally (iv) increase acceptability of having surgical care for non‐traumatic conditions in the groin and genital area. For the latter, fear/no trust was the main reason for receiving no surgical care despite the resulting shame. Conclusions This study defined four focus areas that showed the largest unmet needs that resulted in a perceived disability. For those areas, affordability, availability and acceptability of surgical need to be addressed through technical developments, capacity building and raising awareness.
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Affiliation(s)
| | - Shailvi Gupta
- R Adams Cowley Shock Trauma Center, Baltimore, USA.,Surgeons OverSeas, New York, USA
| | - Reinou S Groen
- Alaska Native Medical Center, Anchorage, USA.,Johns Hopkins Hospital, Baltimore, USA
| | - Dipak Maharjan
- INF Green Pastures Hospital & Rehabilitation Center, Pokhara, Nepal
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Determination of risk factors for burn mortality based on a regional population study in Taiwan. Burns 2018; 44:1591-1601. [DOI: 10.1016/j.burns.2018.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/24/2022]
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15
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Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns 2018; 44:1228-1234. [PMID: 29475744 DOI: 10.1016/j.burns.2018.01.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/27/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Low-and middle-income (LMIC) countries account for 90% of all reported burns, nevertheless there is a paucity of providers to treat burns. Current studies on burns in LMICs have not evaluated the gap between care seeking and receiving. This study explores this gap across socioeconomically similar populations in a multi-country population based assessment to inform burn care strategies. METHODS The Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument is a cross sectional national, cluster random sampling survey administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. The survey identifies burn etiology, demographics, timing, disability, and barriers to receiving care. RESULTS Among 13,763 individuals surveyed, 896 burns were identified. Rwanda had the highest proportion of individuals seeking and receiving care (91.6% vs 88.5%) while Sierra Leone reported the fewest (79.3% vs 70.3%). Rwanda reported the largest disability while Nepal reported the highest proportion with no disability (47.5% vs 76.2%). Lack of money, healthcare providers, and rural living reduce the odds of receiving care by 68% and 85% respectively. CONCLUSIONS Despite similar country socioeconomic characteristics there was significant variability in burn demographics, timing, and disability. Nevertheless, being geographically and economically disadvantaged predict lack of access to burn care.
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Affiliation(s)
- Dattesh R Davé
- Department of Surgery, University of California San Diego, San Diego, CA, USA.
| | - Neeraja Nagarjan
- Department of General Surgery, Brigham and Women's Boston Hospital and Medical Center, Boston, MA, USA
| | - Joseph K Canner
- Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam L Kushner
- Surgeons OverSeas, New York, NY, USA; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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LeBrun DG, Talwar D, Pham TA, Banskota B, Spiegel DA. Predictors of healthcare seeking delays among children with chronic musculoskeletal disorders in Nepal. J Epidemiol Glob Health 2017; 7:299-304. [PMID: 29110873 PMCID: PMC7384576 DOI: 10.1016/j.jegh.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/14/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Healthcare seeking behaviors among children with musculoskeletal disorders are poorly understood. We sought to analyze healthcare seeking delays among children with chronic musculoskeletal conditions in Nepal and identify predictors of clinically significant delays. Methods: A cross-sectional study was conducted at a large pediatric musculoskeletal rehabilitation center in Nepal. Baseline sociodemographic data and healthcare seeking behaviors were assessed via interviews with 75 randomly selected caregivers. Delays of at least 3 months between disease recognition and presentation to a health worker were considered clinically significant. Predictors of significant delay were assessed via multivariable logistic regression. Results: Clubfoot was the most common condition seen in the study sample (N = 33; 37%). Mean and median presentation delays were 33 months and 14 months, respectively. Sixty-seven percent of children were delayed at least 3 months and 40% were delayed at least 2 years. Caregiver occupation in agriculture or unskilled labor was associated with an increased risk of delayed presentation (adjusted OR = 4.05; 95% CI: 1.36–12.09). Conclusions: Children with chronic musculoskeletal disorders in Nepal face significant delays in accessing healthcare. This poses a major clinical problem as the delayed diagnosis and treatment of childhood musculoskeletal disorders can complicate management options and decrease long-term quality of life.
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Affiliation(s)
- Drake G LeBrun
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Divya Talwar
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Tuyetnhi A Pham
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
| | - Bibek Banskota
- Department of Orthopaedics, Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal.
| | - David A Spiegel
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Orthopaedics, Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal.
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17
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He S, Alonge O, Agrawal P, Sharmin S, Islam I, Mashreky SR, Arifeen SE. Epidemiology of Burns in Rural Bangladesh: An Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040381. [PMID: 28379160 PMCID: PMC5409582 DOI: 10.3390/ijerph14040381] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 12/23/2022]
Abstract
Each year, approximately 265,000 deaths occur due to burns on a global scale. In Bangladesh, around 173,000 children under 18 sustain a burn injury. Since most epidemiological studies on burn injuries in low and middle-income countries are based on small-scale surveys or hospital records, this study aims to derive burn mortality and morbidity measures and risk factors at a population level in Bangladesh. A household survey was conducted in seven rural sub-districts of Bangladesh in 2013 to assess injury outcomes. Burn injuries were one of the external causes of injury. Epidemiological characteristics and risk factors were described using descriptive as well as univariate and multivariate logistic regression analyses. The overall mortality and morbidity rates were 2 deaths and 528 injuries per 100,000 populations. Females had a higher burn rate. More than 50% of injuries were seen in adults 25 to 64 years of age. Most injuries occurred in the kitchen while preparing food. 88% of all burns occurred due to flame. Children 1 to 4 years of age were four times more likely to sustain burn injuries as compared to infants. Age-targeted interventions, awareness of first aid protocols, and improvement of acute care management would be potential leads to curb death and disability due to burn injuries.
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Affiliation(s)
- Siran He
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Olakunle Alonge
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Priyanka Agrawal
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Shumona Sharmin
- International Center for Diarrheal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Irteja Islam
- International Center for Diarrheal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Saidur Rahman Mashreky
- Center for Injury Prevention and Research, House # B-162, Road # 23, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Shams El Arifeen
- International Center for Diarrheal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh.
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18
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Tripathee S, Basnet SJ. Epidemiology of burn injuries in Nepal: a systemic review. BURNS & TRAUMA 2017; 5:10. [PMID: 28413803 PMCID: PMC5389177 DOI: 10.1186/s41038-017-0075-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
Burn is a global public health problem associated with significant morbidity and mortality, mostly in low- and middle-income countries. Southeast-Asian countries share a big burden of burn injuries, and Nepal is not an exception. We performed a systemic review to examine the epidemiological characteristics of burn injures in Nepal. Relevant epidemiological studies were identified through systemic search in PubMed, EMBASE, and Google Scholar. Reference lists from relevant review articles were also searched. Studies were included if they meet our selection criteria. Eight studies were included in our systemic review. Most of the burn victims belong to the working age group between 15–60 years old. Flame burns were found to be the most common cause of burn injury followed by scald burns, whereas scald burns were the most common cause of burn injury among the pediatric population. Most patients sustained less severe burn injuries, with home being the most common place of burn injury. The average hospital stay among the burn victims ranged from 13 to 60 days. Mortality among the burn victims ranged from 4.5 to 23.5%, with highest mortality among the flame burn patients. Developed nations have significantly reduced the burn incidence through effective intervention program. Although, burn injuries are the leading cause of morbidity and mortality in Nepal, effective intervention programs are lacking due to the limited epidemiological data related to burn injuries. Further large scale research is imperative to investigate the problem and assess the effectiveness of an intervention program.
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19
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van Loenhout JAF, Delbiso TD, Gupta S, Amatya K, Kushner AL, Gil Cuesta J, Guha-Sapir D. Barriers to surgical care in Nepal. BMC Health Serv Res 2017; 17:72. [PMID: 28114994 PMCID: PMC5260108 DOI: 10.1186/s12913-017-2024-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/17/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Various barriers exist that preclude individuals from undergoing surgical care in low-income countries. Our study assessed the main barriers in Nepal, and identified individuals most at risk for not receiving required surgical care. METHODS A countrywide survey, using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool, was carried out in 2014, surveying 2,695 individuals with a response rate of 97%. Our study used data from a subset, namely individuals who required surgical care in the last twelve months. Data were collected on individual characteristics, transport characteristics, and reasons why individuals did not undergo surgical care. RESULTS Of the 2,695 individuals surveyed, 207 individuals needed surgical care at least once in the previous 12 months. The main reasons for not undergoing surgery were affordability (n = 42), accessibility (n = 42) and fear/no trust (n = 34). A factor significantly associated with affordability was having a low education (OR = 5.77 of having no education vs. having secondary education). Living in a rural area (OR = 2.59) and a long travel time to a secondary and tertiary health facility (OR = 1.17 and 1.09, respectively) were some of the factors significantly associated with accessibility. Being a woman was significantly associated with fear/no trust (OR = 3.54). CONCLUSIONS More than half of the individuals who needed surgical care did not undergo surgery due to affordability, accessibility, or fear/no trust. Providing subsidised transport, introducing mobile surgical clinics or organising awareness raising campaigns are measures that could be implemented to overcome these barriers to surgical care.
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Affiliation(s)
- Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, School of Public Health, Clos Chapelle-aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium.
| | - Tefera Darge Delbiso
- Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, School of Public Health, Clos Chapelle-aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium
| | - Shailvi Gupta
- Department of Surgery, University of California San Francisco East Bay, Oakland, CA, USA
| | - Kapendra Amatya
- Department of Surgical Oncology, Nepal Cancer Hospital, Kathmandu, Nepal
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Surgery, Columbia University, New York, NY, USA.,Surgeons OverSeas, New York, NY, USA
| | - Julita Gil Cuesta
- Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, School of Public Health, Clos Chapelle-aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, School of Public Health, Clos Chapelle-aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium
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20
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Bendix P, Havens JM. The Global Burden of Surgical Disease. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stewart BT, Tansley G, Gyedu A, Ofosu A, Donkor P, Appiah-Denkyira E, Quansah R, Clarke DL, Volmink J, Mock C. Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures. JAMA Surg 2016; 151:e161239. [PMID: 27331865 PMCID: PMC5577012 DOI: 10.1001/jamasurg.2016.1239] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known. OBJECTIVES To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana. DESIGN, SETTING, AND PARTICIPANTS Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014. MAIN OUTCOMES AND MEASURES All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis. RESULTS Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3.3%) performed at least 12. The essential surgical procedure rate was greater in bellwether procedure-capable first-level referral hospitals than in noncapable hospitals (median, 638; interquartile range, 440-1418 vs 360; interquartile range, 0-896 procedures per 100 000 population; P = .03). Population-level spatial access within 2 hours to a hospital that performed 1 to 11 and at least 12 of each bellwether procedure was 83.2% (uncertainty interval [UI], 82.2%-83.4%) and 71.4% (UI, 64.4%-75.0%), respectively. Five hospitals were identified for targeted capability improvement. CONCLUSIONS AND RELEVANCE Almost 30% of Ghanaians cannot access essential surgery within 2 hours. Bellwether capability is a useful metric for essential surgery more broadly. Similar strategic planning exercises might be useful for other low-income and middle-income countries aiming to improve access to essential surgery.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle2Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Gavin Tansley
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada5Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Anthony Ofosu
- Information and Monitoring Unit, Ghana Health Service, Accra
| | - Peter Donkor
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Robert Quansah
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Damian L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa9Department of General Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Kwa-Zulu Natal, South Africa
| | - Jimmy Volmink
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa11Cochrane South Africa, South African Medical Research Council, Tygerberg
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle12Harborview Injury Prevention & Research Center, Seattle, Washington13Department of Global Health, University of Washington, Seattle
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22
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Intentional burns – A form of gender based violence in Nepal. Burns 2016; 42:712. [DOI: 10.1016/j.burns.2015.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 11/23/2022]
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23
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Flynn-O’Brien KT, Trelles M, Dominguez L, Hassani GH, Akemani C, Naseer A, Ntawukiruwabo IB, Kushner AL, Rothstein DH, Stewart BT. Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience. J Pediatr Surg 2016; 51:659-69. [PMID: 26454469 PMCID: PMC5860656 DOI: 10.1016/j.jpedsurg.2015.08.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/16/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. METHODS Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. RESULTS Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1year, use of general anesthesia with a definitive airway, and operation during conflict. CONCLUSION Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions.
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Affiliation(s)
- Katherine T. Flynn-O’Brien
- Department of Surgery, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, Seattle, WA, USA,Corresponding author at: University of Washington, Department of Surgery, 1959 NE Pacific St., Suite BB-487, P.O. Box 356410, Seattle, WA 98195-6410. Tel.: +1 206 543 3680. (K.T. Flynn-O’Brien)
| | - Miguel Trelles
- Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Lynette Dominguez
- Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Ghulam Hiadar Hassani
- Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium,Boost General Hospital, Médecins sans Frontières, Lashkar-Gah, Afghanistan
| | - Clemence Akemani
- Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium,General Referral Hospital, Médecins sans Frontières, Lubutu, Democratic Republic of the Congo
| | - Aamer Naseer
- Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium,Dargai DHQ Hospital, Dargai, Pakistan
| | - Innocent Bagura Ntawukiruwabo
- Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium,General Referral Hospital, Médecins sans Frontières, Masisi, Democratic Republic of the Congo
| | - Adam L. Kushner
- Surgeons OverSeas (SOS), New York, NY, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Surgery, Columbia University, New York, NY, USA
| | - David H. Rothstein
- Department of Surgery, Women & Children's Hospital of Buffalo, NY, USA,Department of Surgery, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Barclay T. Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA,School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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24
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Stewart BT, Lafta R, Esa Al Shatari SA, Cherewick M, Burnham G, Hagopian A, Galway LP, Kushner AL. Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey. Burns 2015; 42:48-55. [PMID: 26526376 DOI: 10.1016/j.burns.2015.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. METHODS A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. RESULTS Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn. CONCLUSION Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; School of Public Health, Kwame Nkrumah University, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Riyadh Lafta
- Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Megan Cherewick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gilbert Burnham
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Hagopian
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Lindsay P Galway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
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25
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Abstract
Burn injuries are a serious global public health concern with significant worldwide mortality and morbidity rates. Burns are among the most devastating of all injuries, with outcomes ranging from physical impairment and disability to emotional and mental consequences. Paediatric burns requiring treatment often incur significant health and opportunity costs, and frequently result in death or long-term disability. A recent systemic review showed that almost 50% of patients hospitalised with severe burns in Europe were younger than 16 years of age, and nearly 60% were male. This report discusses the case of a 2-year-old boy with second and third-degree skin burns over almost 45% of his body, including his head and arms, who presented to the eye clinic at the State Hospital in Hakkari 1 month after a fire burn accident. Both eyes had been burnt and the bilateral anterior chambers had been injured so badly that the patient was left blind.
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Affiliation(s)
- Şeref Istek
- Department of Ophthalmology, Hakkari State Hospital, Hakkari, Turkey
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26
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Sharma NP, Duke JM, Lama BB, Thapa B, Dahal P, Bariya ND, Marston W, Wallace HJ. Descriptive Epidemiology of Unintentional Burn Injuries Admitted to a Tertiary-Level Government Hospital in Nepal. Asia Pac J Public Health 2015; 27:551-60. [DOI: 10.1177/1010539515585386] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study describes the epidemiology of unintentional adult burn injury admissions in a tertiary hospital in Nepal, from 2002 to 2013, focusing on gender-specific patterns. Chi-square tests and Wilcoxon Rank Sum tests were performed. There were 819 unintentional burn admissions: 52% were male and 58% younger than 35 years. The median percentage total body surface area burned (interquartile range) was greater in females than in males ( P < .001): 28% (17-40) versus 20% (12-35), and female mortality was higher (32% vs 11%). A higher proportion females were illiterate than males (48% vs 17%). Burns occurred at home (67%), work (28%), and public places (5%); gender-specific patterns were observed. Flame burns accounted for 77%, electricity 13%, and scalds 8%. Kerosene (31%) and biomass (27%) were the major fuels. Cooking, heating, and lighting were the main activities associated with burn injury. Results support interventions to reduce the use of open fires and kerosene and to promote electrical safety.
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Affiliation(s)
| | - Janine M. Duke
- The University of Western Australia, Crawley, Western Australia, Australia
| | | | | | | | | | | | - Hilary J. Wallace
- The University of Western Australia, Crawley, Western Australia, Australia
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